Cost effectiveness of screening for intracranial aneurysms among patients with bicuspid aortic valve: a Markov modelling study

ObjectiveBicuspid aortic valve (BAV) is common and 7.7%–9.8% of patients with BAV have intracranial aneuryms (IAs) which might lead to a devastating subarachnoid haemorrhage (SAH). We aimed to evaluate different screening and follow-up strategies using magnetic resonance angiography for IAs among patients with BAV.MethodsA decision-analytic model was built to evaluate the costs and effectiveness of different management strategies from the Chinese healthcare payer’s perspective. The evaluated strategies included natural history without screening for possible IAs, regular screening and no follow-up for detected IAs, and regular screening with regular follow-up (Screen strategy/Follow-up strategy). Base case calculation, as well as probabilistic, one-way, and two-way sensitivity analyses, were performed.ResultsAccording to the base case calculation, natural history had the least cost and effectiveness while Every 5 years (y)/Annual gained the highest cost and effectiveness. Every 10y/Biennial was cost effective when compared with Every 10y/Every 5y under the willingness-to-pay threshold of ¥211 743 (US$30 162). Probabilistic sensitivity analysis showed that Every 10y/Biennial was superior in 88.3% of the cases when compared with Every 10y/Every 5y. One-way and two-way sensitivity analyses proved that Every 10y/Biennial was the dominant strategy under most circumstances.ConclusionsScreening for possible IAs among patients with BAV and follow-up for detected IAs would increase the effectiveness. Every 10y/Biennial was the optimal strategy from the Chinese healthcare payer’s perspective.

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Cost-effectiveness analysis of screening for first-degree relatives of patients with bicuspid aortic valve

European Heart Journal ◽

10.1093/eurheartj/ehab724.3156 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

I Tessler ◽

M Leshno ◽

A Shmueli ◽

S Shpitzen ◽

R Durst ◽

...

Keyword(s):

Cost Effectiveness ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Cost Effectiveness Analysis ◽

Public Institution ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

First Degree Relatives ◽

Effectiveness Analysis ◽

Life Years

Abstract Introduction Bicuspid aortic valve (BAV) is the commonest congenital heart valve defect, found in 1% to 2% of the general population and associated with life-threatening complications. Given the high heritability index of BAV, many experts recommend echocardiography for first-degree relatives (FDRs) of an index patient. However, the cost-effectiveness of such cascade screening for BAV has not been fully evaluated. Materials and methods Using a decision-analytic model, we performed a cost-effectiveness analysis of echocardiographic screening of FDRs of BAV index cases. Data on BAV probabilities and BAV complications among FDRs were derived from our institution's BAV familial cohort and from the relevant literature on population-based BAV cohorts with long-term follow-up. Health gain was measured as quality-adjusted life years (QALYs). Cost inputs were based on list prices and literature data. One-way and probabilistic sensitivity analyses were performed to account for uncertainty in the model's variables. Results and disscusion Screening of FDRs was found to be the dominant strategy, being more effective and less costly than no screening, with savings of €208 and gains of 1.6 QALYs. Results were sensitive to the full range of reported BAV rates among FDRs across the literature, with the benefit gradually decreasing from the screening age of 55 years, with trend shifting at the age of 69. Conclusions This economic evaluation model revealed that echocardiographic screening of FDRs of BAV index case is not only clinically important but also highly cost effective and cost-saving. Health gains could be achieved from initiating screening program, along with costs saving. Sensitivity analysis supported the model's robustness, suggesting its generalization. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Center for Interdisciplinary Data Science Research fellowships grant

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P1762 Natural history and outcome of adults with bicuspid aortic valve: a middle-aged french cohort of 541 patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1120 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

Y Bohbot ◽

C Cheng ◽

F Fay ◽

F Elmkies ◽

A L Gugeinheim ◽

...

Keyword(s):

Survival Rate ◽

Aortic Valve ◽

Natural History ◽

Aortic Dissection ◽

Bicuspid Aortic Valve ◽

Large Population ◽

Relative Survival ◽

Surgical Indication ◽

Middle Aged

Abstract Funding Acknowledgements none Background No data are available regarding the natural history and outcomes of middle-aged European patients with bicuspid aortic valve(BAV), as the only 2 large studies were conducted on the other side of the Atlantic. Purpose To determine the frequency of cardiovascular events and to assess the survival relative to that of the general population(GP) in a large population of adults diagnosed with BAV according to the presence or the absence of a surgical indication at baseline. Methods Between 2005 and 2017, 350 patients without surgical indication (mean age 53, 71% men) and 191 patients with surgical indication (mean age 59, 71% men) at baseline were included. Median follow-up was 80 months. Results In the medical group, 34 deaths(9.7%) were recorded(10 cardiovascular). The 10-years survival rate was 88 ± 2% with a relative survival compared to the age-and-sex matched population of 98.8%. Nine patients(2.6%) were diagnosed with infective endocarditis (IE) and no aortic dissection occurred. Aortic valve and/or ascending aorta surgery was performed in 102 patients(29%) during follow-up. In the surgical group, 12 deaths(6.3%) were recorded(5 cardiovascular). The 10-years survival rate was 90 ± 3% with a relative survival compared to the matched population of 99.2%. Five patients(2.6%) were diagnosed with IE and no aortic dissection occurred. Conclusion Middle-aged adults with BAV have a high likelihood of surgery but a survival comparable to the GP. The rate of IE is low and no aortic dissection occurred in our study. Abstract P1762 Figure. a) survival curves B) surgery incidence

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Fate of mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement

10.22541/au.160901985.50675267/v1 ◽

2020 ◽

Author(s):

Alessandro Verzini ◽

Marta Bargagna ◽

Guido Ascione ◽

Alessandra Sala ◽

Davide Carino ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Ascending Aorta ◽

Term Survival ◽

Kaplan Meier ◽

Aortic Root Surgery ◽

Increased Risk ◽

Aorta Replacement ◽

Ascending Aorta Replacement

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. Methods: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (± mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyze. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4±3.9 years, max 16.4). Kaplan Meier estimates were employed to analyze long-term survival. Cumulative incidence function for time to re-operation, recurrence of aortic regurgitation (AR)≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. Results: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63]. At follow-up there were no cases of aortic root surgery whereas 3 patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6±2.5%, 95% CI [0.20-11.53]. At follow up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR>2+/4+ was 5.1±4.98% and of AS>moderate 6.9±3.8%. Conclusions: In our study mild to moderate regurgitation of a BAV did not significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.

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Estimating the Public Health Impact from Introducing Tobacco-Free Nicotine Pouches Into the US

10.21203/rs.3.rs-1124367/v1 ◽

2021 ◽

Author(s):

Peter N Lee ◽

John S Fry ◽

Tryggve Ljung

Keyword(s):

Smoking Status ◽

Health Impact ◽

Sensitivity Analyses ◽

Base Case ◽

Initiation Rate ◽

Individual Parameter ◽

Product Use ◽

The Us ◽

Current Product

Abstract BackgroundFor smokers not intending to quit, switching to a reduced-risk nicotine product should be healthier than continuing smoking. We estimate the health impact, over the period 2000-2050, of introducing into the US the nicotine pouch ZYN. ZYN’s toxicant profile and method of use is like that for Swedish snus, a product with known health effects much less than smoking. MethodsOur modelling approach is similar to others developed for estimating potential effects of new tobacco products. It starts with a simulated cohort of 100,000 individuals in the year 2000 subdivided by age, sex, and smoking status (including years since quitting). They are followed annually accounting for births, net immigrations, deaths and product use changes, with follow-up carried out in the Base Case (ZYN not introduced) and Modified Case (ZYN introduced). Using informed assumptions about initiation, quitting and switching rates, distributions of the population over time are then constructed for each Case, which are used to estimate product-related mortality based on assumptions about the relative risk according to product use. ResultsWhereas in both Base and Modified Cases, the prevalence of any current product use is predicted to decline from about 22% to 10% during follow-up, in the Modified Case about 25% of current users use ZYN by 2050, about a quarter being dual users and the rest ZYN-only users. Over the 50 years, deaths at ages 35-84 from product use among the 100,000 are estimated as 249 less in the Modified than the Base Case, equivalent to about 700,000 less deaths in the whole US. Sensitivity analyses varying individual parameter values confirm the benefits of switching to ZYN, which increase as either the switching rate to ZYN increases or the initiation rate of ZYN relative to smoking increases. Even assuming the reduction in excess mortality risk using ZYN use is 20% of that from smoking rather than the 3.5% assumed in the main analyses, the reduction in product-related deaths would still be 213, or about 600,000 in the US. ConclusionsAlthough such model-based estimates are subject to uncertainties, the results suggest that introducing ZYN could substantially reduce smoking-attributable deaths.

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Aortic diseases

ESC CardioMed ◽

10.1093/med/9780198784906.003.0689_update_001 ◽

2018 ◽

pp. 2861-2863

Author(s):

Bernard Iung

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Marfan Syndrome ◽

Bicuspid Aortic Valve ◽

Young Women ◽

Beta Blockers ◽

Aortic Aneurysms ◽

Maximum Diameter ◽

Aortic Diseases

Aortic diseases encountered in young women are mainly associated with syndromic diseases, which are often heritable, or bicuspid aortic valve. The most frequent syndromic disease is Marfan syndrome. In Marfan syndrome, the risk of aortic dissection is low during pregnancy when the maximum diameter of the ascending aorta is less than 45 mm. Dissection may affect the thoracic ascending or descending aorta. The risk of aortic dissection is low in bicuspid aortic valve when the aortic diameter is less than 50 mm. Beta blockers are recommended throughout pregnancy in Marfan syndrome and are often used in other causes of aortic aneurysms. Close echocardiographic follow-up is needed during pregnancy and after delivery.

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Aortic diseases

ESC CardioMed ◽

10.1093/med/9780198784906.003.0689 ◽

2018 ◽

pp. 2861-2863

Author(s):

Bernard Iung

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Marfan Syndrome ◽

Bicuspid Aortic Valve ◽

Young Women ◽

Beta Blockers ◽

Aortic Aneurysms ◽

Maximum Diameter ◽

Aortic Diseases

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Ten-year follow-up of unreplaced Valsalva sinuses after aortic valve replacement in bicuspid aortic valve disease

Archives of Cardiovascular Diseases ◽

10.1016/j.acvd.2018.11.014 ◽

2019 ◽

Vol 112 (5) ◽

pp. 305-313 ◽

Cited By ~ 1

Author(s):

Ramzi Abi Akar ◽

Noémie Tence ◽

Jérome Jouan ◽

Wassim Borik ◽

Philippe Menasché ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Bicuspid Aortic Valve ◽

Aortic Valve Disease ◽

Valve Disease

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Aortic valve-sparing root replacement in patients with bicuspid aortic valve: long-term outcome with the David I procedure over 20 years

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa083 ◽

2020 ◽

Vol 58 (1) ◽

pp. 86-93 ◽

Cited By ~ 3

Author(s):

Erik Beckmann ◽

Andreas Martens ◽

Heike Krüger ◽

Wilhelm Korte ◽

Tim Kaufeld ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valves ◽

Term Outcome ◽

Long Term Outcome ◽

Initial Surgery ◽

Bicuspid Aortic Valves ◽

Valve Sparing

Abstract OBJECTIVES Aortic valve-sparing root replacement is an excellent treatment option for patients with intact tricuspid aortic valves. However, the durability in patients with bicuspid aortic valves is still a matter of debate. The aim of this study was to analyse the short- and long-term outcomes in patients with bicuspid aortic valves. METHODS Between July 1993 and October 2015, a total of 582 patients underwent the David I procedure, 50 of whom had a bicuspid aortic valve. In these patients, the mean age was 46 ± 13 years, and 80% (n = 40) were men. Follow-up was complete for 100% of patients and comprised a total of 552 patient-years with a mean follow-up time of 11 ± 5.2 years. RESULTS In addition to the David procedure, cusp plication was performed in 34% (n = 17) of patients and commissure repair in 8% (n = 4) of patients. There were no in-hospital deaths, and 1 patient (2%) had a perioperative stroke. The 1-, 5-, 10- and 20-year survival rates of patients after discharge were 98%, 94%, 88% and 84%, respectively. The rates for freedom from valve-related reoperation at 1, 5, 10 and 20 years after initial surgery were 98%, 88%, 79% and 74%, respectively. Long-term freedom from reoperation was comparable to that of patients with tricuspid aortic valves (P = 0.2). CONCLUSIONS The David procedure has excellent short-term results in patients with a bicuspid aortic valve. In this study, the long-term durability of reimplanted bicuspid aortic valves was comparable to that of tricuspid valves. However, careful patient selection might have contributed to this, and further studies might be needed to definitely clarify this issue.

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